China's plans to ban the use of organs harvested from executed prisoners could lead to a stronger culture of donation in the wider population, although the reform could take two decades to implement, according to a former top doctor.

Beijing will set up a national organ donation network in early 2013, according to health officials, while phasing out the use of organs from executed prisoners for transplants.

Interviewed in the World Health Organization's journal Bulletin, top health expert Wang Haibo said that Beijing acknowledges that there are ethical problems with the use of organs from executed prisoners, and that such a system isn't sustainable.

The Red Cross Society of China has run a pilot organ donation scheme over the past two years in some part of China, and the government plans to roll it out nationwide by early next year.

Wang told the journal that a consensus now exists among China’s transplant community that the system should move away from its current "reliance on organs from executed convicts."

According to Wang, who was appointed last year to lead a research center tasked with designing the organ donation network, the "old practice" will be phased out and the new system implemented at around the same time.

'Immoral'

Zeng Jun, a former doctor at Guangzhou's No. 1 People's Hospital, said he believes the use of organs from death-row prisoners is "immoral."

"I think that the decision to ban the use of organs from executed prisoners is very good progress," Zeng said.

"Ordinary people are more and more willing to donate organs, although we still have a very long way to go," he said. "I would guess it will take another 15-20 years before organ donation becomes widely accepted."

In the meantime, a shortage of legally sourced organs for transplant means that the illegal organ trade has become an open secret in today's China, with advertisements clearly visible on the Internet for people wishing to sell kidneys or livers.

Rights groups have long charged China with a deliberate policy of linking the criminal justice system and local hospitals in an attempt to meet the growing demand for transplants after Chinese hospitals became proficient at performing them in the early 1990s.

They also accuse the authorities of skipping over the question of consent, either with coerced agreements before the prisoner is executed, or simply by cremating the bodies of those executed so no evidence remains.

Waiting list

According to the government, 1.5 million patients are on the waiting list for transplant organs in China in any given year, but willing donors are very thin on the ground.

Zeng said that only 15,000 people have signed up for the Red Cross donation scheme so far, however, citing official figures.

"That's a tiny number," he said, adding that cultural beliefs about bodily integrity as a condition for admission to the afterlife often stand in the way of surgical operations, even for patients who need an organ removed.

"I have seen a lot of patients who needed an organ removed in order to stay alive, but their relatives have refused to allow the surgeons to cut away an organ," he said.

"This is because they believe that...the person's body won't be complete after death," he said. "They believe that after you die, you go to a different world, and that you must have bodily integrity...to exist there."

He said that many family members refuse to donate organs to a loved one because of these beliefs, leaving hospitals to rely on organs from people who die suddenly.

"I think it will be hard to change the views of this generation of ordinary people, at least," Zeng said. "But I think in 20 years' time, the next generation will have had a scientific education, and a certain level of acceptance of organ donation."

But he added that there is still no reliable distribution method for organs that will ensure that rich and poor have equal access to the service.

Within five years

According to vice-minister for health Huang Jiefu, China will abolish the transplanting of organs from executed prisoners within five years and try to encourage more citizens to donate, official media reported recently.

Organ transplantation in China has long been criticized as opaque, profit-driven, and unethical. Critics argue death row inmates may feel pressured to become donors, violating personal, religious, or cultural beliefs.

China has also been extracting organs from living prisoners in addition to its much publicized and criticized practice of taking vital body parts from executed convicts, experts told a U.S. congressional hearing in September.

Two-thirds of transplant organs in China come from prisoners, according to researcher Ethan Gutman, who has conducted interviews with Chinese medical professionals, law enforcement personnel, and over 50 former prisoners of China’s laogai labor-camp system since 2006.

Gutman said he believes that the practice of taking organs from Chinese prisoners began in the remote Xinjiang region—where ethnic Uyghurs say they are discriminated against by Han Chinese—in the 1990s and had expanded nationwide by 2001.

Though at first the victims of this practice were executed prisoners, he said, doctors began to take organs from living prisoners as well, he told the Oversight and Investigation and Human Rights Subcommittees of the House of Representatives Foreign Affairs Committee.